A 14-year-old female presented with focal seizure and secondary generalized convulsive
status epilepticus lasting 2 hours. Electroencephalography revealed diffuse slow waves.
Magnetic resonance imaging performed 2 days after onset demonstrated cortical swelling,
gyri effacement, and restricted diffusion affecting the right temporal and parietal
lobes (Figure). The differential diagnosis of these abnormalities included infarction,
ischemia, venous thrombosis, vasculitis, infection, neoplasm, and metabolic
encephalopathy. Because imaging findings were resolved completely after 38 days without
specific treatment aside from supportive seizure therapy, infarction, venous thrombosis,
vasculitis, infection, and neoplasm became less likely. Seizure-induced transient
cerebral swelling was the most probable diagnosis11 . Huang YC, Weng HH, Tsai YT, Huang YC, Hsiao MC, Wu CY et al.
Periictal magnetic resonance imaging in status epilepticus. Epilepsy Res.
2009;86(1):72-81.
http://dx.doi.org/10.1016/j.eplepsyres.2009.05.011
https://doi.org/10.1016/j.eplepsyres.200...
,22 . Rémi J, Vollmar C, Marinis A, Heinlin J, Peraud A, Noachtar
S. Congruence and discrepancy of interictal and ictal EEG with MRI lesions in
focal epilepsies. Neurology. 2011;77(14):1383-90.
http://dx.doi.org/10.1212/WNL.0b013e31823152c3
https://doi.org/10.1212/WNL.0b013e318231...
,33 . Kim JA, Chung JI, Yoon PH, Kim DI, Chung TS, Kim EJ et al.
Transient MR signal changes in patients with generalized tonicoclonic seizure or
status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol.
2001;22(6):1149-60..
(A) Axial FLAIR and (B) coronal T2-weighted images show cortical swelling and gyri effacement in the right temporal and parietal lobes, with a mass effect over the right lateral ventricle; (C) DWI image shows restricted diffusion in this region; (D) Coronal T2-weighted images taken 38 days after onset show no initial feature or sequela.
References
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1Huang YC, Weng HH, Tsai YT, Huang YC, Hsiao MC, Wu CY et al. Periictal magnetic resonance imaging in status epilepticus. Epilepsy Res. 2009;86(1):72-81. http://dx.doi.org/10.1016/j.eplepsyres.2009.05.011
» https://doi.org/10.1016/j.eplepsyres.2009.05.011 -
2Rémi J, Vollmar C, Marinis A, Heinlin J, Peraud A, Noachtar S. Congruence and discrepancy of interictal and ictal EEG with MRI lesions in focal epilepsies. Neurology. 2011;77(14):1383-90. http://dx.doi.org/10.1212/WNL.0b013e31823152c3
» https://doi.org/10.1212/WNL.0b013e31823152c3 -
3Kim JA, Chung JI, Yoon PH, Kim DI, Chung TS, Kim EJ et al. Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001;22(6):1149-60.
Publication Dates
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Publication in this collection
Oct 2014
History
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Received
28 May 2014 -
Reviewed
16 June 2014 -
Accepted
04 July 2014